Daoudia Myriam, Decruynaere Céline, Le Polain de Waroux Bernard, Thonnard Jean-Louis, Plaghki Léon, Forget Patrice
Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Haute Ecole Leonard de Vinci, Institut Parnasse-Deux Alice, Brussels, Belgium.
BMC Anesthesiol. 2015 Dec 16;15:183. doi: 10.1186/s12871-015-0167-9.
The predictive value of an individual's attitude towards painful situations and the status of his immune system for postoperative analgesic requirements are not well understood. These may help the clinician to anticipate individual patient's needs.
Sixty patients, who underwent a laparoscopic cholecystectomy under standardised general anaesthesia, were included. The total analgesic requirements during the first 48 h were the primary endpoint (unitary dosage, UD). The individual's attitude towards imaginary painful situations was measured with the Situational Pain Scale (SPS). The emotional status was assessed by the Hospital Anxiety and Depression Scale (HADS) and the inflammatory status by the neutrophil-to-lymphocyte ratio (NLR).
Univariate analyses revealed a significant association between UD and SPS, HADS and NLR. A negative relationship between SPS and NLR (NLR = 0.820-0.180SPS;R(2) = 0.211;P < 0.001) and a positive relationship between SPS and HADS (HADS = 14.8 + 1.63SPS; R(2) = 0.159;P = 0.002) were observed. A multiple linear regression analysis showed that the contribution of NLR to the UD was the most effective. A mediation analysis showed a complete mediation of the effect of SPS on UD (R(2) = 0.103;P = 0.012), by the NLR (SPS on NLR: R(2) = 0.211;P = <0.001), the HADS (SPS on HADS: R(2) = 0.159;P = 0.002). The variance in UD explained by the SPS was indirect and amounts to 46% through NLR and to 34% through HADS.
In this series, preoperative pain-related attitudes (SPS) were associated with the postoperative analgesic requirements (UD) after a cholecystectomy. Eighty per cent of this effect was mediated by the HADS and the NLR.
个体对疼痛情况的态度及其免疫系统状态对术后镇痛需求的预测价值尚未得到充分理解。这些因素可能有助于临床医生预测个体患者的需求。
纳入60例在标准化全身麻醉下接受腹腔镜胆囊切除术的患者。术后48小时内的总镇痛需求为主要终点（单位剂量，UD）。使用情境疼痛量表（SPS）测量个体对想象中疼痛情况的态度。通过医院焦虑抑郁量表（HADS）评估情绪状态，通过中性粒细胞与淋巴细胞比值（NLR）评估炎症状态。
单因素分析显示UD与SPS、HADS和NLR之间存在显著关联。观察到SPS与NLR之间呈负相关（NLR = 0.820 - 0.180SPS；R² = 0.211；P < 0.001），SPS与HADS之间呈正相关（HADS = 14.8 + 1.63SPS；R² = 0.159；P = 0.002）。多元线性回归分析表明，NLR对UD的贡献最为显著。中介分析显示，NLR（SPS对NLR：R² = 0.211；P = <0.001）和HADS（SPS对HADS：R² = 0.159；P = 0.002）对SPS对UD的影响具有完全中介作用。SPS解释的UD方差是间接的，通过NLR为46%，通过HADS为34%。
在本系列研究中，术前与疼痛相关的态度（SPS）与胆囊切除术后的术后镇痛需求（UD）相关。这种影响的80%由HADS和NLR介导。
